Program Forms

REMINDER: As per USDA, the Program Forms should be distributed on or about the beginning of the school year. *Forms cannot be distributed before July 1.

Operational Forms

Common Logon Permissions for NSLP/Direct Certification PDF
Health and Nutrition Services Entity Data Form (ADD/CHANGE/DELETE) PDF
Food Program Permanent Service Agreement (2 originals must be submitted for ADE approval) PDF
Free and Reduced Price Policy Statement Word
If applicable to your operation, please also include:
  • Addendum- Provision 2
Word
  • Addendum- Provision 3
Word
  • Addendum- Community Eligibility Provision (CEP)
Word
  • Addendum- Non-Pricing
Word
Public Media Release Word
Reimbursement Rates for SY 16-17 – Coming Soon! PDF
ALL FORMS UPDATED FOR SY 2016-2017

Application Packet: Free and Reduced-Price Meals

Distribute forms to households no sooner than July 1

Parent Letter for School Meals English Spanish
Instructions for Household Application for Free and Reduced-Price Meals English Spanish
Household Application for Free and Reduced-Price Meals English Spanish
Parent/Guardian Consent for Sharing Information English Spanish
Foster Outreach Letter – USDA Sample Template PDF Word

Customized Parent Letters

  • Parent Letter for Provision 2/3 Base Year
    *Use the instructions and the household application for free and reduced-price meals posted above.
English Spanish
  • Parent Letter for Provision 2/3 Non-Base Year
English Spanish
  • Parent Letter for Community Eligibility (CEP)
English Spanish
  • Parent Letter, non-pricing, collect applications
    *Use the instructions and the household application for free and reduced-price meals posted above.
English Spanish
  • Parent Letter for Special Milk, applications, charge
    *Use the instructions and the household application for free and reduced-price meals posted above.
English Spanish
  • Parent Letter for Special Milk, do not collect applications, charge
English Spanish
  • Parent Letter for Special Milk, do not collect applications, do not charge
English Spanish

Certifying Income Eligible Children

Income Eligibility Guidelines (IEGs) for SY 16-17 PDF
Notification of Benefits Letter, School Meals English Spanish
Notification of Benefits Letter, Special Milk English Spanish
Notification for Free School Meals Letter, Direct Certification English Spanish

Verifying Household Applications

Error-Prone Worksheet for SY 16-17 PDF
Verification Tracking Form PDF
Verification for Cause Tracking Form PDF
Notification of Verification Letter English Spanish
Notice of Verification Results Letter English Spanish

Meal Pattern Related Forms

Production Record (with menu contributions) PDF Word
Production Record (no menu contributions) PDF Word
Production Record for Multiple Grades PDF Word
Production Record for After School Care Snack Program PDF Word
Standardized Recipe Template (ADE) – Active PDF Version PDF
Weekly Meal Pattern Charts (NSLP)
Weekly Meal Pattern Charts (SBP)

Professional Standards Related Forms Coming Soon!

Training Tracker (Director)
Training Tracker (Manager)
Training Tracker (Full-Time Staff)
Training Tracker (Part-Time Staff)
Training Tracker (Non-Program Staff)
Hiring Tracker for Director’s Hired after July 1, 2015
(10,000+ enrollment)
Hiring Tracker for Director’s Hired after July 1, 2015
(2,500-9,999 enrollment)
Hiring Tracker for Director’s Hired after July 1, 2015
(less than 2,499 enrollment)

Additional Forms

After School Care Snack Program Site Review Form PDF Word
Civil Rights Compliance Form PDF Word
Civil Rights USDA “Justice for All” Posters Request [email protected]
Daily Edit Check Worksheet PDF Word
Daily Edit Check Worksheet (Active Excel) XLS
Internal On-Site Monitoring Form PDF Word
Memorandum of Understanding PDF Word
Non-Program Food Revenue Tool & Calculator XLS
Paid Lunch Equity (PLE) Tool for SY 16-17 XLS
Request for Exempted Fundraisers (HNS 04-2015) Policy and Exempt Fundraiser Request
Request for Whole Grain-Rich Product Exemption (HNS 33-2016) Policy and WG Exemption Request
Smart Snacks Calculator Online Tool
Special Diet Order Form (Disabled Student) PDF Word
Special Diet Order Form (Non-Disabled Student) PDF Word
Summary of Meals Served Worksheet PDF Word
Temperature Logs – Cooler/Freezer PDF
Temperature Logs – Dry Storage PDF